A cluster-randomized trial assessing the impact of school water, sanitation and hygiene improvements on pupil enrolment and gender parity in enrolment

Abstract

We employed a cluster randomized trial design to measure the impact of a school based water, sanitation, and hygiene (WASH) improvement on pupil enrollment and on gender parity in enrollment, in primary schools in Nyanza Province, Kenya (2007-2009). Among schools with poor water access during the dry season, those that received a water supply, hygiene promotion and water treatment (HP&WT) and sanitation improvement, demonstrated increased enrollment (β=0.091 [0.009, 0.173] p=0.03), which translates to 26 additional pupils per school on average. The proportion of girls enrolled in school also increased by 4% (prevalence ratio (PR)=1.04 [1.00, 1.07] p=0.02). Among schools with better baseline water access during the dry season (schools that didn't receive a water source), we found no evidence of increased enrollment in schools that received a HP&WT intervention (β=0.016 [-0.039, 0.072] p=0.56) or the HP&WT and sanitation intervention (β=0.027 [-0.028, 0.082]p=0.34), and there was no evidence of improved gender parity (PR=0.99 [0.96, 1.02] p=0.59, PR=1.00 [0.97, 1.02] p=0.75, respectively). Our findings suggest that increased school enrollment and improved gender parity may be influenced by a comprehensive WASH program that includes an improved water source; schools with poor water access during the dry season may benefit most from these interventions.

The impact of a school-based water supply and treatment, hygiene, and sanitation programme on pupil diarrhoea: a cluster-randomized trial

“…Contiguous districts were grouped into three geographical strata: Nyando/Kisumu, Rachuonyo, and Suba districts. This study was part of a 5-year applied research programme assessing the health impact, educational impact, knowledge diffusion, and sustainability of a school-based WASH intervention [11,[15][16][17][18].…”

‘Fit for school’ – a school-based water, sanitation and hygiene programme to improve child health: Results from a longitudinal study in Cambodia, Indonesia and Lao PDR

“…The benefit of school-based handwashing with soap is now well established; this intervention alone has been shown to prevent around one-third of diarrhoea episodes in children [9]. There is promising evidence from a few recent cluster-randomized trials that WinS programmes, such as school-based hygiene promotion, water treatment and improved sanitation, are effective in reducing pupil absenteeism by 21% to 58%, in some cases specifically for girls [10–13]. However, there are not many studies evaluating the benefits of WinS programmes on children’s health outcomes [7], which are generally challenging to measure.…”

The Role of Adherence on the Impact of a School-Based Water, Sanitation, and Hygiene Intervention in Mali

“…[3][4][5][6][7][8] Improvements to WASH at schools have sometimes been shown to reduce diarrheal disease, 6,9 acute respiratory infections, 10 soil-transmitted helminth reinfections, 11 and absence among pupils. 3,12 However, these effects are often not consistent between studies and within studies they are dependent on study context and/or the subgroup of pupils under study.…”